Vale Dr John Sarno: ‘America’s best doctor’

On 22nd June 2017, Dr John E Sarno passed away at the age of 93. Sarno was a doctor at New York University, and achieved fame for his unique approach to chronic pain, an approach which led satisfied patient and Forbes’ finance writer Edward Siedle to call him “America’s best doctor”.

An ABC “20/20” segment from 1999 introduced Dr Sarno with stories of remarkable recovery from back pain and other debilitating pains through a treatment regime that defied the medical mainstream.

What was this mysterious new treatment?

Dr Sarno talked to his patients.

After a thorough examination to rule out other illnesses or injuries, his patients – many of whom had run out of conventional treatment options – sat through a three hour lecture in which they were told that their brain was creating physical pain to distract them from “unacceptable” emotions like anger.

The pain was real, but the cause was not bulging disks or degenerating joints. The cause was in their own minds, and in the perfectionist, driven, people-pleasing personality traits that made them suppress their stress and rage.

Remarkably, Sarno’s lecture alone was enough to reduce or totally remove most of his patients’ pain, with others requiring one-on-one therapy to help clarify the relationship between their pain and their psychological stress.

A leap of faith

One of the studies cited by Sarno was a 1994 New England Journal of Medicine paper that performed MRI scans on people without back pain, only to discover that the vast majority had abnormalities, and only 36% had normal discs at all levels.

The authors concluded that “the discovery of a bulge or protrusion on an MRI scan in a patient with low [lumbar] back pain may frequently be coincidental.”

Studies that cast doubt on the etiology of back pain have given hope to people for whom contemporary medical treatments offer little relief. If the pain is not caused by a bulging disc, then it may be possible to overcome the pain without invasive or futile attempts to correct the physical abnormality.

Yet it nonetheless requires a leap of faith for people with often crippling back pain and other forms of chronic pain to accept that the real cause of their ailment is emotional.

Perhaps that’s why many of Sarno’s supporters tell similar stories of having “tried everything” and reaching the limits of what modern medical treatments could offer, before finally turning to Dr Sarno for help.

Beyond back pain

Sarno’s theory has increasingly come to the attention of people suffering from illnesses or ailments other than back pain, for which mainstream medicine has proven inadequate or unsatisfactory.

For about four or five years I suffered from an auto-immune disease called Ankylosing Spondylitis (AS).

The disease began with painful bouts of iritis – inflammation of the iris of the eye – and eventually progressed to inflammation of the sacroiliac joints (SI joints) where the spine meets the hip bones.

The prognosis for AS is not good. Left untreated, it can result in fusion of the vertebrae as the joints of the spinal column slowly calcify.

Treatment options have improved with modern medicine, firstly with the recognition that bed-rest is counter-productive, secondly with non-steroidal anti-inflammatory drugs, and finally with more advanced drugs that suppress aspects of the immune system and stop the inflammation from happening in the first place.

But the idea of inhibiting my immune system to stop it destroying my joints left me cold.

I wasn’t just pessimistic about the treatment options, I was angry at having such an illness in the first place.

As a rule I don’t take illness very well. A bout of the common cold feels like a personal encounter with the problem of suffering and why things go wrong. And if that’s true of an external invader like the cold virus, how much more so an auto-immune condition: the disease equivalent of accidentally punching yourself square in the face.

The meaning behind the pain

It took several years, and a lot of effort for me to overcome the symptoms of AS. Sarno’s work helped, but it wasn’t the final answer. In the end I had to discover for myself the specific state of mind and psychological conditions that triggered each bout of painful inflammation in my SI joints.

But Sarno and the loose community of people he helped and inspired were indispensable to my own recovery.

It’s hard to convey the significance of not only finding relief from long-standing and debilitating physical pain, but finding relief in the meaningful context of one’s own psychological traits.

For me, overcoming the symptoms of AS was more than just freedom from pain, it was a vindication of a deeper meaning and significance in my own life, often sensed but sometimes forgotten.

Sarno’s work is not mainstream because his theory was novel and not yet verified or supported by the standards required of evidence-based medicine.

With due respect to the medical profession, those of us living with chronic pain are entitled to investigate plausible alternatives that pass a reasonable risk-benefit analysis and are supported, as Sarno’s work is, by reliable accounts of success.

Sarno’s theory may well turn out to be incorrect in its purported mechanism, or incomplete in its view of the mind-body relationship. But it has helped enough people to make it worth investigating for those of us in real pain right now.

“Flags. Parades. Beaches. Fireworks. On the 241st anniversary of the adoption of the Declaration of Independence, these photographs remind us that we are still one nation, united.’” That’s the optimistic introduction to a New York Times photo summary of Independence Day activities across America on July 4th, and good to read in the country’s leading oracle.

In Auckland, New Zealand, July 5th has only a few hours to run and tomorrow will bring probably the biggest street event of the year: a victory parade of the Kiwi Americas Cup team returning from Bermuda where they sailed their, er, boat (a catamaran that can rise on foils clean out of the water) to a stunning 7-1 win. Maybe that’s a good omen for the All Blacks, who are playing against a visiting British and Irish Lions rugby team.

People love it when they are able to celebrate what their country does well and what it means to them. Sport, for all its professionalism and commercial sponsorship (EmiratesTeam NZ, note), has enormous power to put people in a good mood.

In the light of some crazy trends (see below) feeling good about your country is not enough to make it good, but it can at least energise us for the necessary dialogue and debate over cultural issues.